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Intraoperative hypotension and perioperative acute ischemic stroke in patients having major elective non-cardiovascular non-neurological surgery
ConclusionOur analysis suggests that when MAP is less than 60  mmHg for more than 20 min, there is increased odds of acute ischemic stroke. Further studies are needed to determine what MAP should be targeted during surgery to optimize cerebral perfusion and limit ischemic stroke risk.
Source: Journal of Anesthesia - February 9, 2021 Category: Anesthesiology Source Type: research

Effect of Intraoperative Arterial Hypotension on the Risk of Perioperative Stroke After Noncardiac Surgery: A Retrospective Multicenter Cohort Study
CONCLUSIONS: This study found no evidence to conclude that intraoperative hypotension within the range studied was associated with early perioperative stroke within 7 days after surgery. These findings emphasize the importance of perioperative cerebral blood flow autoregulation to prevent ischemic stroke.PMID:34252055 | DOI:10.1213/ANE.0000000000005604
Source: Anesthesia and Analgesia - July 12, 2021 Category: Anesthesiology Authors: Karuna Wongtangman Luca J Wachtendorf Michael Blank Stephanie D Grabitz Felix C Linhardt Omid Azimaraghi Dana Raub Stephanie Pham Samir M Kendale Ying H Low Timothy T Houle Matthias Eikermann Richard J Pollard Source Type: research

Combined Arterial Hypertension and Ischemic Stroke Exaggerate Anesthesia-Related Hypotension and Cerebral Oxygenation Deficits: A Preclinical Study
CONCLUSIONS: Our findings are the first demonstration that ischemic stroke per se increases the severity of IOH, particularly when combined with a prior history of hypertension; this combination appears to compromise penumbral perfusion.PMID:36730724 | DOI:10.1213/ANE.0000000000006263
Source: Anesthesia and Analgesia - February 2, 2023 Category: Anesthesiology Authors: Tracy Zhang Pratik Thakkar Tonja W Emans Debra Fong Suma Thampi Igor S A Felippe Carolyn J Barrett Robyn Billing Douglas Campbell Fiona D McBryde Source Type: research

Endovascular thrombectomy in acute ischemic stroke: new treatment guide
Purpose of review Recent randomized clinical trials (RCTs) have demonstrated strong efficacy of endovascular thrombectomy (EVT) for acute ischemic stroke (AIS) from large vessel occlusions (LVO). SIESTA, AnSTROKE, GOLIATH showed no deleterious effects of general anesthesia on patient outcome after EVT compared with conscious sedation. DAWN and DEFUSE 3 are extending the time window for EVT up to 24 h in carefully selected patients. This review discusses the current literature on the rapidly expanding subject of endovascular stroke therapy and optimal anesthetic management. Recent findings Recent retrospective studie...
Source: Current Opinion in Anaesthesiology - August 1, 2018 Category: Anesthesiology Tags: NON-OPERATING ROOM ANESTHESIA: Edited by Mark S. Weiss Source Type: research

Volatile sedation with sevoflurane in intensive care patients with acute stroke or subarachnoid haemorrhage using AnaConDa(R): an observational study
Conclusion Sevoflurane led to sufficient sedation, but decreased MAP and CPP in a selected cerebrovascular neurocritical care population. In about a third of these patients, severe adverse reactions, including intolerable ICP increases, were observed.
Source: British Journal of Anaesthesia - May 19, 2015 Category: Anesthesiology Authors: Purrucker, J. C., Renzland, J., Uhlmann, L., Bruckner, T., Hacke, W., Steiner, T., Bosel, J. Tags: Neurosciences And Neuroanaesthesia Source Type: research

Predicting stroke volume and arterial pressure fluid responsiveness in liver cirrhosis patients using dynamic preload variables: A prospective study of diagnostic accuracy
The objective was to evaluate SV and arterial pressure fluid responsiveness in liver cirrhosis patients by using dynamic preload and vascular tone variables. DESIGN: A prospective study of diagnostic accuracy. SETTINGS: A single-centre trial conducted from November 2013 to April 2015. PATIENTS: Thirty-one adult patients, recipients of a living donor liver transplantat. INTERVENTION: An intraoperative fluid challenge with 10 ml kg−1 of 0.9% normal saline. MAIN OUTCOME MEASURES: PPV, SVV, cardiac index and systemic vascular resistance index were measured using the Pulse index Continuous cardiac system. The PVI and...
Source: European Journal of Anaesthesiology - August 3, 2016 Category: Anesthesiology Tags: Cardiovascular physiology Source Type: research

Evaluation of the risk factors for neurological and neurocognitive impairment after selective cerebral perfusion in thoracic aortic surgery
ConclusionsWe found that prolonged SCP time and coronary artery disease increased the risk of postoperative stroke. Heterogeneous carotid plaque, history of cerebrovascular disease, concomitant CABG and prolonged operation time were further significant predictors of POCD.
Source: Journal of Anesthesia - May 1, 2020 Category: Anesthesiology Source Type: research

Preload Dependence Is Associated with Reduced Sublingual Microcirculation during Major Abdominal Surgery
Conclusions Preload dependence was associated with reduced sublingual microcirculation during major abdominal surgery. Fluid administration successfully restored microvascular perfusion.
Source: Anesthesiology - March 12, 2019 Category: Anesthesiology Source Type: research

Anesthesia management for endovascular treatment
Purpose of reviewThe review highlights recent data regarding the safety and efficacy of endovascular treatment of cerebrovascular disease and concerns in anesthesia management. Recent findingsOngoing trials, including the Barrow Ruptured Aneurysm Trial and the International Subarachnoid Aneurysm Trial II, are aimed at improving understanding of the applicability of the International Subarachnoid Aneurysm Trial data and the roles of surgical clipping and endovascular treatment in the broad general patient population of ruptured aneurysms. Two recent studies in unruptured brain arteriovenous malformation management – ARUBA...
Source: Current Opinion in Anaesthesiology - October 1, 2014 Category: Anesthesiology Tags: NEUROANESTHESIA: Edited by Kristin Engelhard Source Type: research

Cerebral Near-Infrared Spectroscopy Monitoring and Neurologic Outcomes in Adult Cardiac Surgery Patients: A Systematic Review.
CONCLUSIONS:Reductions in rSco(2) during cardiac surgery may identify cardiopulmonary bypass cannula malposition, particularly during aortic surgery. Only low-level evidence links low rSco(2) during cardiac surgery to postoperative neurologic complications, and data are insufficient to conclude that interventions to improve rSco(2) desaturation prevent stroke or POCD. PMID: 23267000 [PubMed - as supplied by publisher]
Source: Anesthesia and Analgesia - December 24, 2012 Category: Anesthesiology Authors: Zheng F, Sheinberg R, Yee MS, Ono M, Zheng Y, Hogue CW Tags: Anesth Analg Source Type: research

Targets of perioperative fluid therapy and their effects on postoperative outcome: A systematic review and meta-analysis.
CONCLUSIONS: This systematic review identified three goals for perioperative fluid administration, targeting of which appeared to be associated with less postoperative complications and shorter intensive care unit/hospital lengths of stay. Perioperative mortality remained unaffected. PMID: 25220553 [PubMed - as supplied by publisher]
Source: Minerva Anestesiologica - November 16, 2014 Category: Anesthesiology Tags: Minerva Anestesiol Source Type: research

Comparison of Levosimendan versus Dobutamine in Patients with Moderate to Severe Left Ventricular Dysfunction Undergoing Off-pump Coronary Artery Bypass Grafting: A Randomized Prospective Study.
CONCLUSIONS: Levosimendan was associated with statistically significant increase in indices of contractility (CI, LVSWI, and RVSWI) and decrease in PCWP during and after OPCAB. Levosimendan group had lower incidence of atrial fibrillation, shorter length of ICU, and hospital stay. PMID: 28393781 [PubMed - in process]
Source: Annals of Cardiac Anaesthesia - April 1, 2017 Category: Anesthesiology Authors: Kandasamy A, Simon HA, Murthy P, Annadurai M, Ali MM, Ramanathan G Tags: Ann Card Anaesth Source Type: research

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